Some people who obsess about their tongue and ALS also begin believing they have slurred speech. They may hear or sense that they are slurring their words.

Slurred speech in bulbar ALS is the result of inadequate electrical conduction of nerve cells; the muscle fibers that these cells fire to receive impaired signals; hence, slurred speech (speech is controlled by muscles).

This nerve damage does not come and go. Once a person with bulbar ALS develops slurred speech, this symptom is there to stay.

So if what you perceive as slurred speech comes and goes…this heavily points away from bulbar ALS.

“Examining one’s tongue in the absence of any symptoms is not helpful, as there is no reason that the tongue should be affected clinically in the absence of any symptoms,” says Dr. Gerecke.

But what if you’re thinking that the twitching that you see in your tongue is only the first symptom of bulbar ALS, and that soon, more will follow? After all, wouldn’t there have to be a first symptom?

By the time a person with bulbar ALS sees their tongue twitching from the disease, the patient already has the symptoms (or some of) that Dr. Gerecke pointed out already.

And the tongue fasciculations of bulbar ALS look more like a bunch of worms squirming under the tongue, not the “twitching” that a healthy person sees in the mirror.

Dr. Gereckehas a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.

Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.